An Updated Decision Model

The most effective treatment for menopausal symptoms is hormone therapy, which also decreases the risk of osteoporosis and colorectal cancer. However, hormone therapy increases the risk of coronary heart disease, stroke, pulmonary embolism and breast cancer and the net risks of hormone therapy appear to outweigh its benefits for most women. To examine the trade-off between symptom relief and risk of serious disease resulting from short-term hormone therapy (two years or less), investigators employed a Markov model to simulate lifetime incidence of various diseases along with literature-based quality of life scores. Investigators found that 50-year old women using hormone therapy for two years will experience a 12-day loss of life expectancy, when impact on quality of life is not considered. However, quality-adjusted life expectancy increases 4.3 months for women with mild menopausal symptoms who were at low risk for cardiovascular disease and 3.3 months for high-risk women. Women with severe symptoms experienced increases of 8.3 or 6.9 months of quality-adjusted life expectancy, respectively. In general, as the severity of symptoms increases, so does the increase in quality-adjusted life expectancy, with smaller gains for women at higher risk for coronary vascular disease. The authors conclude that short-term hormone therapy is beneficial or harmful depending on a woman's treatment goal (maximizing longevity or maximizing quality-adjusted life expectancy), the severity of her symptoms and her level of cardiovascular disease risk.